Long term radiological features of radiation-induced lung damage

Veiga, Catarina; Landau, David; McClelland, Jamie R.; Ledermann, Jonathan A.; Hawkes, David J.; Janes, Sam M.; Devaraj, Anand

doi:10.1016/j.radonc.2017.11.003

Cited by 18 publications

(13 citation statements)

References 49 publications

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“…We are currently analyzing IDEAL-CRT follow-up CT scans to understand the etiology of late radiation-induced lung damage. 24,25 CTV/ITV V95% was significantly associated with OS in IDEAL-CRT, with an HR of 0.88 representing a 12% increase in the hazard rate for death per 1% loss in CTV/ITV fractional volume receiving 95% of the prescribed dose. When patients were dichotomized into those with CTV/ITV V 95% >99% or 99% (105 vs 11 patients), an HR of 0.46 (95% CI, 0.23-0.90) was found, favoring the V 95% >99% group.…”

Section: Discussionmentioning

confidence: 99%

Long-Term Results from the IDEAL-CRT Phase 1/2 Trial of Isotoxically Dose-Escalated Radiation Therapy and Concurrent Chemotherapy for Stage II/III Non-small Cell Lung Cancer

Fenwick

Landau

Baker

et al. 2020

International Journal of Radiation Oncology*Biology*Physics

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One-hundred eighteen patients with stage IIB-IV non-small cell lung cancer were treated with isotoxically escalated concurrent chemoradiation to median prescribed doses of 64.5 and 67.6 Gy in 30 fractions over 5 (n Z 36) or 6 weeks (n Z 82). Toxicity was acceptable for both schedules. Overall survival was longer in 6-week than in 5-week patients (median, 41.2 vs 22.1 months; hazard ratio, 0.56; 95% confidence interval, 0.32-0.98; P Z .04). Progression-free survival was also longer in 6-week patients (median, 21.1 vs 8.0 months; hazard ratio, 0.53; 95% confidence interval, 0.33-0.86; P Z .01).Purpose: The IDEAL-CRT phase 1/2 multicenter trial of isotoxically dose-escalated concurrent chemoradiation for stage II/III non-small cell lung cancer investigated two 30-fraction schedules of 5 and 6 weeks' duration. We report toxicity, tumor response, progression-free survival (PFS), and overall survival (OS) for both schedules, with long-term follow-up for the 6-week schedule. Methods and Materials: Patients received isotoxically individualized tumor radiation doses of 63 to 71 Gy in 5 weeks or 63 to 73 Gy in 6 weeks, delivered concurrently with 2 cycles of cisplatin and vinorelbine. Eligibility criteria were the same for both schedules.Results: One-hundred twenty patients (6% stage IIB, 68% IIIA, 26% IIIB, 1% IV) were recruited from 9 UK centers, 118 starting treatment. Median prescribed doses were 64.5 and 67.6 Gy for the 36 and 82 patients treated using the 5-and 6-week schedules. Grade 3 pneumonitis and early esophagitis rates were 3.4% and 5.9% overall and similar for each schedule individually. Late grade 2 esophageal toxicity occurred in 11.1% and 17.1% of 5-and 6-week patients. Grade 4 adverse events occurred in 17 (20.7%) 6-week patients but no 5-week patients. Four adverse events were grade 5, with 2 considered radiation therapy related. After median follow-up of 51.8 and 26.4 months for the 6-and 5-week schedules, median OS was 41.2 and 22.1 months, respectively, and median PFS was 21.1 and 8.0 months. In exploratory analyses, OS was significantly associated with schedule (hazard ratio [HR], 0.56; 95% confidence interval [CI], 0.32-0.98; P Z .04) and fractional clinical/internal target volume receiving 95% of the prescribed dose (HR, 0.88; 95% CI, 0.77-1.00; P Z .05). PFS was also significantly associated with schedule (HR, 0.53; 95% CI, 0.33-0.86; P Z .01). Conclusions: Toxicity in IDEAL-CRT was acceptable. Survival was promising for 6-week patients and significantly longer than for 5-week patients. Survival might be further lengthened by following the 6-week schedule with an immune agent, motivating further study of such combined optimized treatments.

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Section: Discussionmentioning

confidence: 99%

Long-Term Results from the IDEAL-CRT Phase 1/2 Trial of Isotoxically Dose-Escalated Radiation Therapy and Concurrent Chemotherapy for Stage II/III Non-small Cell Lung Cancer

Fenwick

Landau

Baker

et al. 2020

International Journal of Radiation Oncology*Biology*Physics

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“…For example, this could be done by evaluating the accuracy of mapping anatomical landmarks, or by dividing organs into well-defined sub-structures that can be analysed separately. Improving localised mapping is increasingly relevant for clinical endpoints such as brain injury (Gunther et al 2015 , Viselner et al 2019 ), lung fibrosis (Veiga et al 2018 ) and heart failure (McWilliam et al 2017 ). We recommend that in clinical studies investigating organ-specific end-points additional validation is performed accordingly.…”

Section: Discussionmentioning

confidence: 99%

Atlas construction and spatial normalisation to facilitate radiation-induced late effects research in childhood cancer

et al. 2021

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Reducing radiation-induced side effects is one of the most important challenges in paediatric cancer treatment. Recently, there has been growing interest in using spatial normalisation to enable voxel-based analysis of radiation-induced toxicities in a variety of patient groups. The need to consider three-dimensional distribution of doses, rather than dose-volume histograms, is desirable but not yet explored in paediatric populations. In this paper, we investigate the feasibility of atlas construction and spatial normalisation in paediatric radiotherapy. We used planning computed tomography (CT) scans from twenty paediatric patients historically treated with craniospinal irradiation to generate a template CT that is suitable for spatial normalisation. This childhood cancer population representative template was constructed using groupwise image registration. An independent set of 53 subjects from a variety of childhood malignancies was then used to assess the quality of the propagation of new subjects to this common reference space using deformable image registration (i.e. spatial normalisation). The method was evaluated in terms of overall image similarity metrics, contour similarity and preservation of dose-volume properties. After spatial normalisation, we report a dice similarity coefficient of 0.95 ± 0.05, 0.85 ± 0.04, 0.96 ± 0.01, 0.91 ± 0.03, 0.83 ± 0.06 and 0.65 ± 0.16 for brain and spinal canal, ocular globes, lungs, liver, kidneys and bladder. We then demonstrated the potential advantages of an atlas-based approach to study the risk of second malignant neoplasms after radiotherapy. Our findings indicate satisfactory mapping between a heterogeneous group of patients and the template CT. The poorest performance was for organs in the abdominal and pelvic region, likely due to respiratory and physiological motion and to the highly deformable nature of abdominal organs. More specialised algorithms should be explored in the future to improve mapping in these regions. This study is the first step toward voxel-based analysis in radiation-induced toxicities following paediatric radiotherapy.

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“…Patients receiving radiation for NSCLC are at risk of secondary abscesses both from the pneumonitis and fibrosis from the radiation as well as the necrotic tumour itself. Despite this most large studies do not report it as a complication of stereotactic radiotherapy [6]; though a small case series (n = 27) found it occurred in 7% of cases [7].…”

Section: Discussionmentioning

confidence: 99%

Antibiotic instillation for a chronic lung abscess

Ainge‐Allen

Lilburn

Moses

et al. 2020

Respiratory Medicine Case Reports

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IntroductionAntibiotic treatment of lung abscesses fails in 10–20% of cases and require surgery, however, some are unsuitable for resection. Alternative options carry significant morbidity.Case reportA 47 year old man with inoperable non-small cell lung cancer developed a lung abscess following definitive radiotherapy. Initial antibiotic therapy was successful, however four years later his symptoms recurred. Despite multiple courses his symptoms recurred despite long-term antibiotics. Immediately following a diagnostic aspiration, ceftriaxone and metronidazole were instilled into the abscess with subsequent clinical and radiological resolution.DiscussionLung abscesses are an uncommon complication of radiotherapy. Antibiotic therapy can fail for a number of reasons. Although instillation of antibiotics has not been described in the management of lung abscesses, the direct application of antifungals for aspergillomas is well documented and case series report success in other abscess sites.ConclusionDirect antibiotic instillation following lung abscess aspiration adds minimal risk and is potentially curative.

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Long term radiological features of radiation-induced lung damage

Abstract: Parenchymal change, lung shrinkage and pleural change are present in a high proportion of patients and are frequently identified in RILD. GGOs, reticulation and traction bronchiectasis are common at 12 months but not diagnostic.

Cited by 18 publications

References 49 publications

Long-Term Results from the IDEAL-CRT Phase 1/2 Trial of Isotoxically Dose-Escalated Radiation Therapy and Concurrent Chemotherapy for Stage II/III Non-small Cell Lung Cancer

Long-Term Results from the IDEAL-CRT Phase 1/2 Trial of Isotoxically Dose-Escalated Radiation Therapy and Concurrent Chemotherapy for Stage II/III Non-small Cell Lung Cancer

Atlas construction and spatial normalisation to facilitate radiation-induced late effects research in childhood cancer

Antibiotic instillation for a chronic lung abscess

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Long term radiological features of radiation-induced lung damage

Abstract: Parenchymal change, lung shrinkage and pleural change are present in a high proportion of patients and are frequently identified in RILD. GGOs, reticulation and traction bronchiectasis are common at 12 months but not diagnostic.

Cited by 18 publications

References 49 publications

Long-Term Results from the IDEAL-CRT Phase 1/2 Trial of Isotoxically Dose-Escalated Radiation Therapy and Concurrent Chemotherapy for Stage II/III Non-small Cell Lung Cancer

Long-Term Results from the IDEAL-CRT Phase 1/2 Trial of Isotoxically Dose-Escalated Radiation Therapy and Concurrent Chemotherapy for Stage II/III Non-small Cell Lung Cancer

Atlas construction and spatial normalisation to facilitate radiation-induced late effects research in childhood cancer

Antibiotic instillation for a chronic lung abscess

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Product

Resources

About

Abstract: Parenchymal change, lung shrinkage and pleural change are present in a high proportion of patients and are frequently identified in RILD. GGOs, reticulation and traction bronchiectasis are common at 12 months but not diagnostic.